Provider Demographics
NPI:1710153234
Name:UT SOUTHWESTERN MEDICAL CENTER
Entity Type:Organization
Organization Name:UT SOUTHWESTERN MEDICAL CENTER
Other - Org Name:CHILDREN'S MEDICAL CENTER DALLAS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PEDIATRIC CRITICAL CARE
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KERNIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-456-7593
Mailing Address - Street 1:1935 MEDICAL DISTRICT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-7593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty